Written By: Devin Golden
Mesothelioma Pleural Effusion
Pleural effusion is the build-up of fluid in the pleural space. Pleural mesothelioma is often the cause of the pleural effusion. Mesothelioma pleural effusion is a medical condition that can cause chest pain which is often one of the first symptoms of pleural mesothelioma.
Medically Reviewed By
Karen Ritter, RN BSN
Registered Nurse
Medically Reviewed By
Karen Ritter, RN BSN
Registered Nurse
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Everything You Need to Know About Pleural Mesothelioma
Important Facts About Pleural Effusions
- Pleural effusion is a primary symptom of pleural mesothelioma. It is fluid buildup in the pleural cavity, which is where pleural mesothelioma forms.
- Pleural effusion is caused by multiple factors, not including mesothelioma. This condition is diagnosed over 1 million times per year.
- Symptoms of pleural effusions may include dry cough, fever, chills, hiccups or inability to breathe easily unless sitting upright or standing (orthopnea).
- Pleural effusion can be treated surgically. Two options are minimally invasive: thoracentesis and pleurodesis. The other two options are standard pleural mesothelioma surgeries: pleurectomy/decortication and extrapleural pneumonectomy.
What Is Pleural Effusion?
The human body consists of a thin layer of tissue and fluid that lines the lungs inside of the chest cavity. This thin layer is called the pleura, also called the pleural cavity. The pleura’s role is to offer a buffer for the lungs to expand as needed against the chest wall.
The pleura consists of two tissue linings: one against the surface of the lungs and the other against the chest wall. Between these two tissue linings is a thin space that holds a small amount of fluid. A pleural effusion is a condition – also called “fluid around the lungs” or “water on the lungs” – with an abnormal collection of fluid that builds up in the space between the pleura linings.
Approximately 1.5 million people in the United States each year who are are diagnosed with pleural effusions. It’s a common health condition and has a wide range of potential causes. Around 100,000 cases of pleural effusions are due to cancers such as malignant pleural mesothelioma.
There are two types of pleural effusion. Determining the type of pleural effusion can help doctors narrow down the potential causes. They differ in how they are caused:
- Transudative pleural effusion – It’s caused by fluid leaking into the pleural space, which leads to more pleural fluid than there should be. This type is most often due to heart failure.
- Exudative pleural effusion – This is caused by blocked blood vessels or lymph vessels, inflammation, infection or tumors.
Mesothelioma pleural effusion is an example of exudative pleural effusion. Pleural mesothelioma tumors cause excess fluid production and block parietal pleural capillaries that inhibit normal drainage. More fluid within the pleural space means less space for the lungs to expand.
Mesothelioma can also lead to pleural effusion by:
- Forming new blood vessels that leak fluid into the pleural space
- Blocking the lymphatic system from draining fluid out of the pleura
The color of mesothelioma pleural effusion fluid may appear clear, cloudy, bloody, or black. Many medical sources say it looks bloody or black.
What Else Causes Pleural Effusion?
Pleural effusion is a symptom of pleural mesothelioma cancer, but they are not always cancerous. Pleural effusion can be caused by pleural thickening, which is scarring of the tissue in the pleura. Pleural thickening can be caused by asbestos exposure (which causes mesothelioma) or an infection, meaning it can be cancerous or benign (noncancerous).
Another cause of pleural effusion is lung cancer. According to a 2019 study, lung cancer is the most common cause of pleural effusion.
Other Causes of Pleural Effusion
Pneumonia
Heart disease
Liver disease
Kidney disease
Pulmonary embolism (Blood clot stuck in an artery of the lungs)
If you’re experiencing pleural effusion – usually manifesting as chest pain or shortness of breath – then talk with your doctor. You’ll likely undergo tests to determine what is causing your pleural effusion.
Symptoms of Mesothelioma Pleural Effusion
Pleural effusion is an abnormal buildup of pleural fluid, which can cause pressure against the lungs and chest wall. This can lead to chest pain, the main symptom of mesothelioma pleural effusion.
Another symptom is difficulty breathing. Mesothelioma pleural effusion causes less space for the lungs to expand and contract, which leads to pleural pressure, shortness of breath or rapid breathing.
Other common symptoms of pleural effusion include:
- Dry cough
- Fever and chills
- Hiccups
- Orthopnea (inability to breathe easily unless sitting upright or standing)
How to Diagnose Mesothelioma Pleural Effusion
Symptoms are not enough to diagnose pleural effusion. The best way to medically confirm a pleural effusion is through imaging tests.
Imaging tests used to diagnose a pleural effusion:
- Chest X-ray
- CT Scan
- Ultrasound
Chest X-rays can provide a simple look at the structures and organs in the chest. A CT scan gives detailed two-dimensional images of all the structures in the chest – including the heart, lungs, ribs, blood vessels and even lymph nodes. If pleural effusions exist, they will appear on scans as a large opaque mass near your lungs.
Another way to diagnose pleural effusion is with an ultrasound of the lungs and chest cavity. Your doctor may also use a stethoscope to listen to your lungs and tap your chest and upper back. Diagnosing a pleural effusion may be part of the process of diagnosing pleural mesothelioma.
Testing Pleural Effusion for Mesothelioma
The only definitive way to diagnose pleural mesothelioma is through a tissue biopsy. However, some doctors may test pleural fluid for the presence of cancer cells before recommending a biopsy. This is called mesothelioma pleural effusion cytology, or mesothelioma pleural fluid analysis.
If the pleural effusions are caused by pleural mesothelioma, then doctors can remove samples of the fluid in the chest to test for mesothelioma cancer cells. Pleural fluid tests are done by removing fluid samples with a needle inserted into the pleural space.
According to a 2019 study, approximately 60% of cancer cases can be diagnosed by testing pleural effusion fluid from the chest.
Treatment of Pleural Effusion
Treatment for pleural effusion involves draining the excess fluid between the layers of the pleura. This is done through minimally invasive procedures.
Thoracentesis for Pleural Effusion
The main way to treat a pleural effusion is a thoracentesis. This minor surgical procedure can be used to diagnose the cause of pleural effusion and remove the excess fluid from the pleural space, or the gap between the two pleural tissue linings. Thoracentesis is a temporary way of treating pleural effusion because it drains the fluid but does not eliminate the possibility of more fluid building up later.
Doctors insert a needle into the pleural space to remove the excess fluid. If there is a large amount of pleural fluid, then the medical team may attach tubing to the needle to drain fluid quickly. In some cases, doctors may use an indwelling pleural catheter where the pleural catheter will remain in place to allow for continuous drainage of fluid for an extended period of time.
Using a thoracentesis to remove malignant mesothelioma pleural effusions can be considered a palliative cancer treatment. It reduces the symptoms of pleural effusion and mesothelioma in an attempt to improve the patient’s quality of life.
Pleurodesis for Pleural Effusion
Pleurodesis is another minimally invasive surgery to treat pleural effusions. Pleurodesis is a palliative treatment for pleural mesothelioma. Doctors will typically use video-assisted thoracoscopic surgery to remove the fluid from the pleura and chemically seal the pleural space to prevent future effusions. The two tissue linings of the pleura will be fused as a permanent solution to pleural effusions.
While pleurodesis can prevent the occurrence of pleural effusions, it may limit future surgical treatment options for pleural mesothelioma.
Pleurectomy/Decortication
Pleurectomy with decortication surgery removes the pleura, which could eliminate the chance of pleural effusions occurring again. Pleurectomy/decortication is one of the main surgeries for pleural mesothelioma. It’s a way of removing pleural mesothelioma tumors and cancer cells from the lung and the inside of the chest cavity. This is a permanent solution to pleural effusion.
Extrapleural Pneumonectomy
Extrapleural pneumonectomy surgery removes the pleura, plus the entire diseased lung. This is another surgery for pleural mesothelioma to remove tumors within the chest. Removing the pleura eliminates the possibility of pleural effusions occurring again.
Frequently Asked Questions About Mesothelioma Pleural Effusion
What Is Mesothelioma Pleural Effusion?
Mesothelioma pleural effusion is the buildup of fluid in the pleura, which is the thin lining of the lungs and chest wall. The pleura is made up of two tissue linings with fluid in between. Pleural mesothelioma cancer can cause fluid to build up inside of the chest, causing chest pain and shortness of breath. Pleural effusion is a common symptom of pleural mesothelioma.
Does Mesothelioma Cause Pleural Effusion?
Yes. Pleural mesothelioma can cause pleural effusions. Patients with pleural effusions have a buildup of fluid in the pleural space due to mesothelioma tumors, inflammation and scarring. This fluid presses against the lung and chest wall. Mesothelioma also causes pleural effusions by forming blood vessels that leak extra fluid into the pleura and tumors that block the normal draining of pleural fluid into the lymphatic system.
Is Pleural Thickening Serious?
Pleural thickening can be serious, especially if it’s a sign of cancer, such as a symptom of pleural mesothelioma. Pleural thickening can also be a benign condition – meaning it’s not cancerous. People can live with pleural thickening if it’s not a symptom of a more serious condition. However, benign pleural thickening can impact respiratory function and cause breathing issues.
Can Pleural Thickening Be Cured?
Pleural thickening cannot be cured. There are treatment options, such as palliative surgeries and pulmonary rehabilitation, to improve breathing and help the respiratory system function better. However, the buildup of scar tissue is irreversible.
How Is Mesothelioma Pleural Effusion Treated?
Mesothelioma pleural effusion is usually treated with minimally invasive procedures to drain the excess fluid and relieve pressure against the lungs and chest. These minimally invasive procedures are thoracentesis and pleurodesis. Thoracentesis drains fluid from the lungs. Pleurodesis drains fluid and chemically seals the pleural space. There are two surgeries that treat malignant mesothelioma pleural effusion. Pleurectomy with decortication (P/D) and extrapleural pneumonectomy (EPP) are surgical options that are used to treat pleural mesothelioma. Both of these pleural mesothelioma surgeries completely remove the pleura in an effort to remove pleural mesothelioma tumors.
Sources & Author
- About Pleural Effusion. Penn Medicine. Retrieved from: https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/pleural-effusion. Accessed: 03/07/2023.
- Fluid Around the Lungs (Pleural Effusion). Yale Medicine. Retrieved from: https://www.yalemedicine.org/conditions/fluid-around-the-lungs. Accessed: 03/07/2023.
- Pleural Effusion Causes, Signs and Treatment Cleveland Clinic. Retrieved from: https://my.clevelandclinic.org/health/diseases/17373-pleural-effusion-causes-signs–treatment. Accessed: 03/07/2023.
- Thoracentesis. Johns Hopkins Medicine. Retrieved from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/thoracentesis. Accessed: 03/07/2023.
- Pleural Effusion in Adults—Etiology, Diagnosis, and Treatment. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647819/. Accessed: 03/07/2023.
- Pleural Fluid: Visual Appearance and Etiology. Pulmonary Chronicles. Retrieved from: https://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/243/617. Accessed: 03/09/2023.
- Black pleural effusion: etiology, diagnosis, and treatment. Indian Journal of Thoracic and Cardiovascular Surgery. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525393/. Accessed: 03/09/2023.
